Portraits of Breast Cancer
It’s a diagnosis―breast cancer―no one wants to hear. But every year nearly 200,000 women will. Getting through it takes strength and grace―something the women featured here have in spades.
Helena Chang, M.D.Director of the Breast Cancer Program at the Revlon/UCLA Breast Center and a professor and a surgical oncologist at the David Geffen School of Medicine, at the University of California at Los Angeles
Chang directs the Gonda/UCLA Breast Cancer Research Laboratory and the Clinical Trials Unit for Breast Cancer. She has been studying the disease since 1981.
Q. What are the biggest advances in research in recent years?
A. In the past 10 years, the most progress has been made because of the Human Genome Project. We now know that there are many types of breast cancer, and each is affected by a particular set of genes. We also better understand the biology behind cancer progression.
Q. Over the course of your career, how has public perception about breast cancer changed?
A. People aren’t afraid to talk about it. And doctors are engaged in promoting breast cancer screening.
Q. Recently a study suggested that breast self-exams may not help save lives. What’s your take on that?
A. The largest randomized study showed that self-exams have no effect on survival rate and that those who routinely did self-exams ended up having more biopsies that were noncancerous. (But another recent study showed that more cancers were found in women who did self-exams.) Self-exams are still something we should do. Our breasts are part of our body, and it’s our responsibility to be aware of changes―even if it might not have a big impact on saving lives in general. The newer screening tool, breast MRI, is now available for those with a strong family history or those who have tested positive for BRCA mutations, the breast cancer genes that are associated with an excessive risk for the disease, or those with other conditions that put them at high risk. MRI also works well in women who have dense breast tissue, often young women, or those on hormone-replacement treatment. For those who can’t have an MRI―for example, due to pregnancy or kidney problems―we recommend a breast ultrasound in addition to mammography.
Q. Where do you see the most need for new research?
A. We have to figure out a way to target the cancer cells specifically, as opposed to medicine that affects the whole body taking a huge hit, as it often does in chemo. We also have to get rid of the idea that one magic treatment will work for all breast cancer patients. And I think that in the future other types of prevention need to be developed to reduce the incidence of breast cancer in women with average risk of getting the disease.
Q. How has treatment improved in the past few years?
A. Medications have evolved. Chemotherapy, the traditional medicine, kills the tumor cells with more ease than it kills normal cells, but it makes us sick and we lose our hair. The newer drugs, like Herceptin and Lapatinib, have better therapeutic value and fewer side effects.
Q. How are the drugs used?
A. We combine them with chemo. Either one alone is not that magical, but together they’re synergistic. For women who have chemo and take Herceptin, the recurrence rate is over 50 percent lower. And Lapatinib works well for those whose cancer is resistant to Herceptin.
Q. What about the link between chemicals and breast cancer―are the concerns founded?
A. In the olden days, we weren’t exposed to as chemically complex an environment as we are today. Now we eat more processed foods, and we also don’t do as much physical activity. We tend to get married and have children later. We have the Pill and hormone replacement. Breast cancer incidence is associated with better-developed countries―some of that must be environmental.
Q. How do you determine risk and improve a woman’s survival rate if she develops the disease?
A. Some of the most powerful risk factors are being a woman, having a family history of two or more diagnosed first-degree relatives, and getting older. Incidence in your 20s is low, 30s is less likely, but women in their 40s account for 18 percent of all breast cancers. Obesity is linked with an increased risk of cancer―period―and also with postmenopausal breast cancer. The longer you do hormone replacement, the higher your risk. Women with a history of drinking―on average, two to three glasses of alcohol a day―have a 20 to 40 percent increase in risk compared with those who drink less. When it comes to improving the prognosis, research has shown that patients diagnosed with breast cancer who exercise have a 20 to 50 percent lower risk of death from the disease. It’s hard to conduct studies to tell if exercise suppresses recurrence or how it works for healthy women. But we are animal, not vegetable. We are supposed to move and use our physical strength.
Q. How do women who have been diagnosed find the best care?
A. The most important thing is to talk to your doctor in a very open way, to make sure that he or she is addressing all your concerns and that the proposed treatment sounds logical. You will have a multidisciplinary team, with a surgeon and a medical oncologist and a radiologist. If something doesn’t sound right, then get a second opinion.
Next: The New Patient
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